Dalai's note: My rather vocal presentation of my views on medical IT have earned me an international speaking career. It is sad to see that nothing much has changed over all the time I've been blogging and speaking on this issue. In fact, even though it is more ubiquitous, medical software remains as useless and confounding as ever. It is gratifying, however, to see others take up the cause of improving this potentially deadly deficit. As cross-published on KevinMD.com, this piece from Dr. James Salwitz, an oncologist who blogs on SunriseRounds.com, takes a similar approach to lambast those who dump their (soft)wares on an unsuspecting medical community.
Join the #hcldr tweet chat tomorrow at 8:30 pm, ET, as HL7Standards.com contributor Leonard Kish moderates a chat on patient engagement.
Get full details on the chat in the post Do We Have Patient Engagement Backwards?, published on the Healthcare Leadership Blog.
The following topics will be discussed:
And, if you haven’t already, be sure and download Leonard’s new, free, comprehensive patient engagement eBook, titled, “Patient Engagement is a Strategy, Not a Tool. How healthcare organizations can build true patient relationships that last a lifetime,” published right here on HL7Standards.com.
I’ve been having some Internet speed issues as of late, so I searched online and found a speed test. Turns out my download speed is a less than lightning fast at a mere 7.8Mbps – even though I pay for 24Mbps. I called up my Internet provider and had a conversation that went something like this:
Me: I am getting less than 8Mbps speed and I am paying for 24Mbps.
Customer “Service” Guy (CSG): What are you using the Internet for?
Me: Mostly email and online reading. No streaming videos or anything like that.
CSG: Sometimes the speed appears slower because of the websites you are on.
Me: OK…so how do I make it faster?
CSG: Would you like to upgrade your speed to 45Mbps?
Me: Only if I don’t have to pay more.
CSG: Actually it’s $X more a month.
Me: No, I don’t want to pay more. I just want to get the 24Mbps speed I am paying for.
CSG: That’s not something I can help you with.
I confess: I hung up on customer “service” guy. And then I began to ponder how it is that we’ve become a society that fails to take responsibility when problems arise. For every person that steps forward and says, “yep, there’s an issue, let’s figure it out,” another dozen are either ignoring the problem because “fixing” is not part of their jobs, or, quickly placing the blame on someone or something else.
Anyone who has worked in IT knows exactly what I mean. A customer’s system goes down and the software folks blame it on the hardware; the hardware guys blame the Internet provider; the Internet provider blames the customer…and so it goes. And no one is happy.
A more tragic example: Thomas Eric Duncan, the first Ebola patient to die in the U.S., went to the ER with stomach pains, fever, and a headache. Despite telling staff he came from Liberia, the information was overlooked by the physician and Duncan was released. By the time he returned to the hospital a few days later, his condition was severe and he eventually died. Between the first and second hospital visits, Duncan could have infected dozens of people – though thankfully that doesn’t seem to have occurred.
When everyone began asking how the hospital could have missed the Ebola diagnosis with the first visit, hospital officials were quick to blame a glitch on the Epic EMR. However, the EMR was apparently just a convenient scapegoat.
After Epic raised a bit of a fuss, the hospital admitted the fault did not, in fact, lie with the EMR. Let’s face it: the hospital PR folks initially blamed the computer because they thought it sounded better than admitting the doctor made a mistake and didn’t fully read the patient record.
And what about the VA’s appointment scheduling scandal?
Several dozen VA facilities apparently kept “secret” waiting lists for veterans waiting to see a doctor while maintaining “official” waiting lists for reporting purposes. Employees were essentially ordered to cook the books to create the appearance that appointments were made within the VA’s 14-days-from-request goal. The secret list scheme continued until a retired VA doctor came forward as a whistleblower. By the time the truth was revealed, dozens of veterans had died before ever seeing a physician; more than 57,000 waited over 90 days to get an appointment.
How many people were aware these lists were being created and maintained? Hundreds? Thousands? Did they remain quiet because they feared losing their job? Didn’t want to get anyone else in trouble? Didn’t think it was their job to say anything?
Maybe the world needs some sort of 12-step recovery program that encourages people to readily admit when there’s a problem, and, encourages more personal responsibility. Seems like a better alternative than practicing avoidance and continuing to allow the buck to stop on someone else’s desk.
Every November we wish each other a Happy Thanksgiving and express our gratitude for the important things in our lives like friends, family, and good health. Though we often overindulge in foods that probably aren’t beneficial to our health during this time of year there is one thing you can do this holiday season to promote wellness – gather a family health history.
Since 2004, the U.S Surgeon General has designated Thanksgiving as National Family Health History Day. Health problems like heart disease, cancer and certain genetic issues often run along family lines. Having a family history of a disease often means that family members have an increased likelihood of developing the same illness. However, having a tendency for a disease doesn’t mean that you’re certain to develop it. Often interventions like exercise, diet or medications can help ward off disease and keep an individual healthy. But in order to intervene, patients and their healthcare professionals need to know what they’re up against. So now that you’ve divvied up all your Thanksgiving leftovers, it’s a good time to talk about and write down health issues that run in the family and create a family health history.
It’s never too early to start collecting a family health history. While I was pregnant, I was able to undergo a non-invasive test to see if I was a carrier for genetic abnormalities like Fragile X and Cystic Fibrosis. This was a new test not available a few years ago and it would be wise to have it performed before a woman becomes pregnant so she can be aware of the risks and treatment options.
The CDC encourages pregnant women and those considering pregnancy to know her and the baby’s father’s family health histories to help decrease or discover health issues. The agency says family health histories are valuable in early detection of genetic disorders in children. Young adults can benefit from early screening based on family history.
To organize and access your family health history you can use the Surgeon General’s web-based tool My Family Health Portrait. It collects your information and creates a “pedigree” that can be downloaded and saved privately. You can share the information with your family and your healthcare provider.
It’s often said that if you don’t have your health, you don’t have anything. Take advantage of the holiday’s family togetherness and get your family health history together.
Healthcare executives are continuously evaluating the subject of RFID and RTLS in general. Whether it is to maintain the hospitals competitive advantage, accomplish a differentiation in the market, improve compliance with requirements of (AORN, JCAHO, CDC) or improve asset utilization and operating efficiency. As part of the evaluations there is that constant concern around a tangible and measurable ROI for these solutions that can come at a significant price.
When considering the areas that RTLS can affect within the hospital facilities as well as other patient care units, there are at least four significant points to highlight:
Disease surveillance: With hospitals dealing with different challenges around disease management and how to handle it. RTLS technology can determine each and every staff member who could have potentially been in contact with a patient classified as highly contagious or with a specific condition.
Hand hygiene compliance: Many health systems are reporting hand hygiene compliance as part of safety and quality initiatives. Some use “look-out” staff to walk the halls and record all hand hygiene actives. However, with the introduction of RTLS hand hygiene protocol and compliance when clinical staff enter or use the dispensers can now be dynamically tracked and reported on. Currently several of the systems that are available today are also providing active alters to the clinicians whenever they enter a patient’s room and haven’t complied with the hand hygiene guidelines.
Locating equipment for maintenance and cleaning:
Having the ability to identify the location of equipment that is due for routine maintenance or cleaning is critical to ensuring the safety of patients. RTLS is capable of providing alerts on equipment to staff.
A recent case of a hospital spent two months on a benchmarking analysis and found that it took on average 22 minutes to find an infusion pump. After the implementation of RTLS, it took an average of two minutes to find a pump. This cuts down on lag time in care and can help ensure that clinicians can have the tools and equipment they need, when the patient needs it.
There are also other technologies and products which have been introduced and integrated into some of the current RTLS systems available.
There are several RTLS systems that are integrated with Bed management systems as well as EHR products that are able to deliver patient order status, alerts within the application can also be given. This has enabled nurses to take advantage of being in one screen and seeing a summary of updated patient related information.
Unified Communication systems:
Nurse calling systems have enabled nurses to communicate anywhere the device is implemented within the hospital facility, and to do so efficiently. These functionalities are starting to infiltrate the RTLS market and for some of the Unified Communication firms, it means that their structures can now provide a backbone for system integrators to simply integrate their functionality within their products.
In many of the recent implementations of RTLS products, hospital executives opted to deploy the solutions within one specific area to pilot the solutions. Many of these smaller implementations succeed and allow the decision makers to evaluate and measure the impacts these solutions can have on their environment. There are several steps that need to be taken into consideration when implementing asset tracking systems:
• Define the overall goals and driving forces behind the initiative
• Develop challenges and opportunities the RTLS solution will be able to provide
• Identify the operational area that would yield to the highest impact with RTLS
• Identify infrastructure requirements and technology of choice (WiFi based, RFID based, UC integration, interface capability requirements)
• Define overall organizational risks associated with these solutions
• Identify compliance requirements around standards of use
RFID is one facet of sensory data that is being considered by many health executives. It is providing strong ROI for many of the adapters applying it to improve care and increase efficiency of equipment usage, as well as equipment maintenance and workflow improvement. While there are several different hardware options to choose from, and technologies ranging from Wi-Fi to IR/RF, this technology has been showing real value and savings that health care IT and supply chain executives alike can’t ignore.
It was not long after mankind invented the wheel, carts came around. Throughout history people have been mounting wheels on boxes, now we have everything from golf carts, shopping carts, hand carts and my personal favorite, hotdog carts. So you might ask yourself, “What is so smart about a medical cart?”
Today’s medical carts have evolved to be more than just a storage box with wheels. Rubbermaid Medical Solutions, one of the largest manufacturers of medical carts, have created a cart that is specially designed to house computers, telemedicine, medical supply goods and to also offer medication dispensing. Currently the computers on the medical carts are used to provide access to CPOE, eMAR, and EHR applications.
With the technology trend of mobility quickly on the rise in healthcare, organizations might question the future viability of medical carts. However a recent HIMSS study showed that cart use, at the point of care, was on the rise from 26 percent in 2008 to 45 percent in 2011. The need for medical carts will continue to grow; as a result, cart manufacturers are looking for innovative ways to separate themselves from their competition. Medical carts are evolving from healthcare products to healthcare solutions. Instead of selling medical carts with web cameras, carts manufacturers are developing complete telemedicine solutions that offer remote appointments throughout the country, allowing specialist to broaden their availability with patients in need. Carts are even interfaced with eMAR systems that are able to increase patient safety; the evolution of the cart is rapidly changing the daily functions of the medical field.
Some of the capabilities for medical carts of the future will be to automatically detect their location within a healthcare facility. For example if a cart is improperly stored in a hallway for an extended period of time staff could be notified to relocate it in order to comply to the Joint Commission’s requirements. Real-time location information for the carts could allow them to automatically process tedious tasks commonly performed by healthcare staff. When a cart is rolled into a patient room it could automatically open the patient’s electronic chart or give a patient visit summary through signals exchanged between then entering cart and the logging device kept in the room and effectively updated.
Autonomous robots are now starting to be used in larger hospitals such as the TUG developed by Aethon. These robots increase efficiency and optimize staff time by allowing staff to focus on more mission critical items. Medical carts in the near future will become smart robotic devices able to automatically relocate themselves to where they are needed. This could be used for scheduled telemedicine visits, the next patient in the rounding queue or for automated medication dispensing to patients.
Innovation will continue in medical carts as the need for mobile workspaces increase. What was once considered a computer in a stick could be the groundwork for care automation in the future.
This has been an eventful year for speech recognition companies. We are seeing an increased development of intelligence systems that can interact via voice. Siri was simply a re-introduction of digital assistants into the consumer market and since then, other mobile platforms have implemented similar capabilities.
In hospitals and physician’s practices the use of voice recognition products tend to be around the traditional speech-to-text dictation for SOAP (subjective, objective, assessment, plan) notes, and some basic voice commands to interact with EHR systems. While there are several new initiatives that will involve speech recognition, natural language understanding and decision support tools are becoming the focus of many technology firms. These changes will begin a new era for speech engine companies in the health care market.
While there is clearly tremendous value in using voice solutions to assist during the capture of medical information, there are several other uses that health care organizations can benefit from. Consider a recent product by Nuance called “NINA”, short for Nuance Interactive Natural Assistant. This product consists of speech recognition technologies that are combined with voice biometrics and natural language processing (NLP) that helps the system understand the intent of its users and deliver what is being asked of them.
This app can provide a new way to access health care services without the complexity that comes with cumbersome phone trees, and website mazes. From a patient’s perspective, the use of these virtual assistants means improved patient satisfaction, as well as quick and easy access to important information.
Two areas we can see immediate value in are:
Customer service: Simpler is always better, and with NINA powered Apps, or Siri like products, patients can easily find what they are looking for. Whether a patient is calling a payer to see if a procedure is covered under their plan, or contacting the hospital to inquire for information about the closest pediatric urgent care. These tools will provide a quick way to get access to the right information without having to navigate complex menus.
Accounting and PHR interaction: To truly see the potential of success for these solutions, we can consider some of the currently used cases that NUANCE has been exhibiting. In looking at it from a health care perspective, patients would have the ability to simply ask to schedule a visit without having to call. A patient also has the ability to call to refill their medication.
Nuance did address some of the security concerns by providing tools such as VocalPassword that will tackle authentication. This would help verify the identity of patients who are requesting services and giving commands. As more intelligence voice-driven systems mature, the areas to focus on will be operational costs, customer satisfaction, and data capture.
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John Lynn, prolific blogger and health IT media magnate, and I are teaming up again for the second year to produce and deliver a marketing conference focused on helping digital health, health IT, and medical device innovators. We’re going to be providing actionable advice and specific techniques you can use to cut through the noise when trying to market healthcare and medical tech products to physicians, hospitals, health systems, ACOs, patients, and similar customers. Called The Healthcare IT Marketing Conference, last year’s event covered very important subjects by some of the world’s best experts on those topics and we’ll continue the tradition again in 2015.
Learn the difference between Marketing, Advertising, PR, and Branding
Everyone tells small companies that they need to “do marketing” but that’s really hard to do so I started with a quick visual to explain what it means. It comes from Marty Neumeier on pages 24 and 25 of ZAG by way of the Brand Autopsy Blog (which I highly recommend reading) and illustrates the differences between Marketing, Advertising, PR, and Branding. It’s a wonderful visual and clearly shows that small companies should focus on marketing and free PR, shoot for branding and probably eschew advertising until they have enough money. Our expert speakers at HITMC know the difference and will teach you how to make sure you’re not taking the wrong steps.
Learn how to conduct appropriate market research
Lots of (even innovative) companies don’t do basic market research so we will cover:
Learn about the different kinds of of Business Models to consider
Learn about major healthcare industry fallacies
Selling to the healthcare community is very hard and there are many myths that our conference will dispel:
Learn how to align the Payers, Beneficiaries, and Users (PBU) of your Health IT or MedTech product
There are three distinct groups you’re marketing and selling your products to:
I call this the “PBU alignment” problem. In a complex environment like healthcare, the three groups are often not the same — if you can find a market in which the payers, the beneficiaries, and the users are all the same then your sales job is easy. However, that’s commonly not the case. Let’s take a look at the typical example of a complex product like an electronic medical records (EMR) software package in the era of ARRA, HITECH, and meaningful use (MU). The “payer” may ultimately be government reimbursements through Medicare, the “beneficiaries” are the healthcare insurance firms and the government agencies that need the MU data, and the “users” are the doctors and staff at physicians offices and hospitals. Why has it taken decades for EMRs to be sold to just a tiny fraction of the total industry? Because the PBU alignment hasn’t been reached — until the users, beneficiaries, and payers of the products all understand the value and are willing to work together to achieve a goal it will be tough.
Join us at the conference to talk with experts on the PBU lesson and advice for your product. Figure out the PBU alignment problem and see how you’ll sell to each of the groups and make the right arguments — you do it right and you’ll make money. If you forget the complexities of the PBU and you’ll be languishing, too.
Go home with many tips and tricks:
Earlier this year NueMD created a nice looking Meaningful Use Infographic — asking the question whether MU was helping or hurting EHR Adoption. I loved the summary but I wanted to dig in a little further so I asked Dr. William Rusnak, a resident physician in radiology and a healthcare IT writer for NueMD, to tell us what that infographic meant for innovators and folks building solutions. Here’s what Dr. Rusnak said:
When the Centers for Medicare and Medicaid Services (CMS) launched their Electronic Health Records (EHR) Incentive Programs, coined “Meaningful Use” (MU) back in January 2011, the main goal was to reward healthcare practitioners and administrators for adopting EHRs and increasing efficiency within their practice. NueMD, a medical billing software company, decided to take a closer look at the effectiveness of this program. They compiled research from the Department of Health and Human Services (HHS), CMS, and the American College of Physicians (ACP) looking to identify adoption trends and determine potential obstacles to successful implementation.
The results are quite interesting and have shed some light upon the massive opportunity for technical breakthroughs in healthcare. If tech innovators want to join the movement, they should be continually searching for processes in medicine that still involve some sort of manual transmission of information. Talk to your friends that are nurses, doctors, office managers, billers, or administrators. You would be surprised simply by the amount of information still being written on papers and stuffed in pockets throughout the day!
Adoption, attestation, and a younger generation of physicians
According to a survey of more than 1,200 physicians, EHR adoption is certainly taking place, but when it comes to officially attesting to Meaningful Use – the numbers suggest there’s still room for improvement. Practices with more than 50 physicians had the highest rate of EHR adoption at 85%, with 62% attesting to MU. The big disparity exists among small practices (less than 10 providers) in which half have implemented EHR technology, while only 25% have attested to MU.
This will improve, though. With younger physicians beginning to practice and take on leadership positions, it is very likely that adoption rates will increase substantially over the next decade. In the past, one of the biggest challenges EHR vendors have faced is working with a userbase that wasn’t keen on technology. Soon, however, the majority of practicing physicians will be of the generation that was introduced to technology much earlier in life. Additionally, Medical Economics states that even many older physicians have become comfortable in using technology in their practices, claiming that this age-group has begun to see some of the highest rates of EHR adoption. Thus, the market, not only only for EHR, but also nearly any kind of health technology, is just about ready to surge.
User satisfaction and efficiency, or lack thereof
Although this data suggests EHR adoption is on the rise, providers’ feelings about implementing and using EHRs is showing another trend. Between March 2010 and December 2012, user satisfaction decreased 13% from 61% to 48% while dissatisfaction rose 14% from 23% to 37%. What’s to blame? Of those surveyed, 67% claimed system functionality as their primary reason for switching EHR vendors.
One could look at this on the surface and think that since satisfaction is decreasing, healthcare information technology (HIT) is a struggling industry. But, let’s not kid ourselves. HIT is here to stay and most of the gripes and complaints about EHR are typical for any developing technology. If anything, these data suggest that within this storm of inefficiencies exist ample opportunities for improvement. Developers should take this into consideration for future healthcare software. More emphasis needs to be the true effectiveness of the software. This problem could be solved rather quickly with focus groups consisting of healthcare providers. Let them pick apart your software and find bottlenecks, set-backs, and other negative features. In the end, the electronic version of any process must absolutely be less time-consuming than the old-fashioned paper method.
Another very common complaint of many EHR systems is that the usability is far from intuitive. This could be the lowest-hanging fruit in the tree of improvements to this kind of software. Although each user will differ in education — from patient to nurse to physician — all of them should be able to easily access any and all of the health information stored from the patient encounters. Innovators can easily overcome this obstacle by make a significant effort to create simple, user-friendly interfaces. Again, use focus groups or chat with current clients and find out where users struggle with simple tasks. Are there too many unused features on the “home” page? Is there are particular action that users frequently perform, but must search through several menu options to get to it?
The data entry dilemma
The next problem is rather complicated and that is of data entry. Currently, physicians and other providers are using either dictation software or typing to get information into the EHR. Streamlining this process even further will decrease the time necessary for documentation, thus providing more time for the patient interview. Innovators should be looking to try to design alternative ways input information into EHRs.
Since most devices now have voice recognition, an app that could allow physicians to quickly record the patient interview then allow for review and submission into any EHR would be an amazing product. It would be even more impressive if the app could create custom documents and help to avoid repetition. For example, physicians could record physical exam findings while s/he speaks them during the exam. This eliminates some documentation after the interview.
In the future, similar apps for wearables will be even more helpful. Imagine devices, such as otoscopes, thermometers, blood pressure cuffs, and stethoscopes recording data directly into the EHR as you use them. This reality is not too far off and any software that facilitates this data collection is likely to thrive.
Government intervention: Does it help or hurt?
Let’s get back to the question at hand. Is the government’s intervention helping or hurting? Unfortunately, the positive effects of the incentives seemed to have plateaued, given the lower amount of attestations in 2013. Furthermore, in a few rare instances, they have actually indirectly caused some healthcare leaders to commit fraud. A hospital CFO in Texas aided the hospital in receiving $800,000 in MU incentives, yet the system barely used its EHR. He was also reported to commit identity fraud in order to receive MU incentives. Additionally, on the innovation side of things, much of the funding in the form of grants, has run out, leaving most of the HIT companies that received them struggling to sustain themselves.
There are some good points. MU has initiated the transition to EHR for both vendors and providers. It was a surge of development in healthcare. In the process, providers were given software that was quickly designed and lacked key features. Therein lies the opportunity. Innovators now have customers with large demand for features such as usability, interoperability between software packages, and mobile implementation. Even though the EHR space in particular is crowded, there is still room for companies to create better patient portals, educational apps, analytics apps for wearables, and additional software that can be integrated into existing EHRs. And as far as the drought of government funds, venture funding for healthcare start-ups and companies is still plentiful.
Bad news can be good news
Overall, this data should be a wake-up call to everyone in the industry. Hospitals and smaller practices are struggling with the transition to a completely electronic system. Not to mention, they are unable to achieve true interoperability – open communication channels between everyone involved in patient care. However, this massive amount of problems is really a gold mine for HIT entrepreneurs. My advice to these innovators in the industry is to start connecting with physicians (or any other healthcare professional) willing to provide constructive input. Being that kind of doctor myself, I can tell you that I want nothing more than for developers to collaborate with those of us on the front lines of patient care. It’s only going to result in better software and devices.
I’ve written a number of articles and a few video interviews on job opportunities in digital health recently and have received a steady stream of questions since then. Given healthcare IT professionals can make $90,000 or more annually, there has been growing interest in the industry. To help separate fact from fiction and dive a little deeper in to the realities of these opportunities, I reached out to Beth Kelly, a freelance writer from Chicago, IL to summarize the projected outlook for specialized positions within the field of health IT. Careers in healthcare IT are appealing whether your preference lies within the computer or medical sciences; what’s clear though is to succeed you’ll need to have your passion fit somewhere between both. As positions in the industry are constantly evolving, the ability to adapt to new technology is also crucial — whatever is “cool” today will be different tomorrow. As healthcare providers and physicians strive to implement new technology systems, the expertise of HIT professionals will guide the industry into the future so knowing the Outcome Driven Innovation (OID) and JTBD of clinical professionals will be a differentiator for those who possess such skills. The market for health care information technology continues to show enormous growth potential – with no signs of slowing down any time soon. Here’s what Beth thinks the outlook is:
General Qualifications and Useful Certifications
It’s clear that the expanding field of healthcare IT affords plenty of opportunities. But of course, making the move into this field isn’t as simple as picking up the phone and interviewing. Qualifications are important — in a recent salary survey report completed by HealthITJobs.com, it was noted that certified workers are on average making $10,000+ more than those without certifications. If you are an IT worker currently, CISSP, CCNA, and PMP are a few technical certifications that are in high demand in Healthcare IT. But beyond the classroom, health IT requires a unique set of skills, and not all of them are related to technology. In healthcare, the right applicant needs to understand more than codes and processes. Many hiring managers look for applicants with “soft skills” who are willing to work in a highly collaborative environment. Applicants for HIT positions need to be aware that in a hospital environment, their position is not the star of the show. Ultimately the healthcare world revolves around the patient, and IT roles provide supportive care. In many cases when hiring, institutions prefer applications with a combination of IT and clinical skills.
Optimizing opportunities afforded by the changing healthcare landscape requires a lot of hard work and insight into the diverse nature of the healthcare IT job market. Whether you are transitioning to IT from a clinician position, or you have an IT background already but are new to healthcare, challenges are inevitable. But in an increasingly digital world, where people use technology in more ways perhaps than they even realize, an HIT skill set is almost guaranteed to pay off.
The healthcare sector of IT is as diverse as the industry itself. There are numerous areas in which to specialize; the following domains being several of the most promising.
Looking purely at the numbers, Americans are inseparable from their phones. And with nearly one third of all mobile applications being health related, the opportunity to access and utilize vast amounts of health data is there, also. As Silicon Valley tech companies take a greater interest in mobile health devices, advances in analytic software now make it possible to capture illuminating data about our daily lives. The sum of this information is aimed to transform medicine. Even as privacy concerns loom, the ubiquity of smartphones and tablets promises career opportunities in the realm of HIT.
Joseph Hobbs, CIO at Community Hospital at Anderson located in Anderson, Indiana, had this to say about mobile technologies: “This is a huge topic for any organization. Whether it is a mobile cart, a tablet or a smartphone, you need to give caregivers access at their fingertips. The [other] challenge in healthcare is that it’s not a one-size-fits-all initiative. Beyond just finding a solution for all you then have to worry about security and application presentation to all of these types of devices.”
Many health professionals agree that the data from medical devices and data from modern EHR solutions should be integrated. When mobile devices are capable of being linked to EHR, physicians can provide patients with appointment alerts and medication reminders, as well as additional medical assistance. In the remote patient monitoring space, cell service provider Verizon represents the Converged Health Management solution, one of the first products that hopes to bridge the gap between monitoring devices and EHRs. Partnering with Ideal Life, a medical device company, Verizon’s platform is capable of measuring blood pressure, oxygen saturation, glucose levels and weight.
The market for mobile healthcare apps promises many new opportunities for with room tremendous growth and earning potential. According to German market research firm research2guidance, the worldwide market for mobile health applications and their corresponding services reached $2.4 billion in revenue in 2013 and will grow to $26 billion by the end of 2017.
Mobile apps are becoming increasingly significant in the healthcare community, their influence extending throughout both the medical and insurance industries. Mobile app developer positions are in extremely high demand. With medical health app growth ahead of the general mobile market, there are tremendous number of opportunities for people interested in these positions. According to the U.S. Bureau of Labor and Statistics, from the years 2010-2020, there is a projected growth rate of 57.4% for software application developers. For software systems developers, there is a projected growth rate of 71.7%. It’s estimated that overall employment in the industry will continue to grow rapidly.
Clinical analytics are a top priority for two reasons: data mined by those with analytic skill can be used to understand population health, helping better identify infectious disease outbreaks and other population health trends, and can also be used to help a hospital’s bottom line. Big data allows providers to better see how their resources are spent, and where they can trim the fat. The recent deal between Apple and IBM only promises to fuel the market for data analyst positions.
In the current market, an advanced degree in health informatics is very useful. Because of the move toward electronic health records, hospitals and health systems need qualified people to undertake complex projects. A degree opens the door to working for a hospital, a health system, a vendor that sells electronic records or computer software or as a professional consultant. From 2010 to 2020, the U.S. bureau of Labor has said that employment of computer systems analysts in computer systems design and related services will grow 43 percent. Businesses will typically hire them to reorganize IT departments to operate more efficiently.
HIPAA, Meaningful Use and ICD-10 Project Managers
Now that both HIPAA and HITECH are being fully enforced, affected entities can be audited for compliance at any time. At Stage 2 of the HITECH act a certain percentage of provider’s patients must use and interact with patient portals. Navigating HIPAA privacy regulations and the proprietary nature of the portal software is a convoluted process. And the transition from ICD-9-CM to ICE-10-CM is a hefty task as well; ICD-9-CM contains 13,000 3-5-character alphanumeric diagnosis codes with 855 code categories. ICD-10-CM contains 68,000 3-7-character alphanumeric diagnosis codes with 2,033 code categories. In the transition to greater coding specificity, hospitals typically look for someone who has worked as a coder and in health information management roles.
As health organizations strive toward integrating ICD-10 throughout every aspect of their business, there is an enormous need for medical coding and billing specialists capable of working with the updated diagnostic coding system. ICD-10 skills will put you in the front running for an in-demand position such as project manager, ICD-10 coding specialist, or even ICD-10 educator.
Skills in HIPAA Compliance qualify you for a high level HIPAA Privacy Officer position, a role that typically pays over $60,000 annually. Meaningful Use Director positions, a recent addition to the healthcare landscape, can pay anywhere between $35-80,000 each year.
Privacy and Data Breach Prevention Specialists
Health Information privacy specialists are in extremely high demand. EHR applications, particularly when accessed on mobile devices, require enhanced security access and monitoring. Data breaches are expensive, embarrassing, and damaging to to health groups, but many physicians still neglect to encrypt the patient information they’ve stored on various devices. Healthcare organizations need to take security seriously, and bring on IT professionals to ensure they are doing everything they can to reduce instances of identity theft.
Information security spending is expecting to increase nationwide, especially within industries that deal with sensitive information such as hospitals. New security measures are added and reconfigured constantly, and as a result the demand for privacy and data protection specialists is always high. Job growth for this title is projected to grow upwards of 25% within the next 5-10 years.
Pharmaceutical companies, naturally interested in joining the digital health movement as well, have found it more difficult to gain traction. A 2013 Deloitte survey found that, while people trust doctors and medical professionals the most, they trust companies like WedMD next and then internet search results. Big pharma companies come in dead last. Healthcare organizations and pharma companies are competing, not within their respective sectors, but against one another. Digital pharma is only now beginning to take off. According to M2i2′s Chief Medical Information and Innovation Officer Sachin Jain in a May interview, “the ultimate incentive is that we as a company are gradually finding our way into the outcomes improvement business, as opposed to the pill and vaccine business, and as we do that, I think we realize that data and technology and HIT is going to be a critical enabler.”
Getting started in healthcare IT is not as intimidating as it may seem. For new job seekers, however, it is important to research the different types of positions available and where you may be most helpful. Additionally, for those without a background in health, learning clinical workflows and the other processes that go into healthcare is imperative. Experience, if it’s outside the realm of healthcare, can be transferable, but you will need to be sure to tailor your resume and cover letter around the language of the health industry. If possible, volunteer in a hospital or similar healthcare IT setting to obtain hands-on experience.
Unlike humans, which can handle diversity, computers hate variations. Hospitals and physicians have experienced workflow disruptions and productivity loss as they adopt more advanced EHR systems. Health IT workers, cogs in the digital health machine, fulfill hybrid roles that blend the skills of clinicians and traditional IT workers. As the nature of the healthcare industry continues to evolve, the future for healthcare IT continues to look very bright.
“Large collections of electronic patient records have long provided abundant, but under-explored information on the real-world use of medicines. But when used properly these records can provide longitudinal observational data which is perfect for data mining,” Duan said. “Although such records are maintained for patient administration, they could provide a broad range of clinical information for data analysis. A growing interest has been drug safety.”
In this paper, the researchers proposed two novel algorithms—a likelihood ratio model and a Bayesian network model—for adverse drug effect discovery. Although the performance of these two algorithms is comparable to the state-of-the-art algorithm, Bayesian confidence propagation neural network, by combining three works, the researchers say one can get better, more diverse results.
I saw this a few weeks ago, and while I haven't had the time to delve deep into the details of this particular advance, it did at least give me more reason for hope with respect to the big picture of which it is a part.
It brought to mind the controversy over Vioxx starting a dozen or so years ago, documented in a 2004 article in the Cleveland Clinic Journal of Medicine. Vioxx, released in 1999, was a godsend to patients suffering from rheumatoid arthritic pain, but a longitudinal study published in 2000 unexpectedly showed a higher incidence of myocardial infarctions among Vioxx users compared with the former standard-of-care drug, naproxen. Merck, the patent holder, responded that the difference was due to a "protective effect" it attributed to naproxen rather than a causative adverse effect of Vioxx.
One of the sources of empirical evidence that eventually discredited Merck's defense of Vioxx's safety was a pioneering data mining epidemiological study conducted by Graham et al. using the live electronic medical records of 1.4 million Kaiser Permanente of California patients. Their findings were presented first in a poster in 2004 and then in the Lancet in 2005. Two or three other contemporaneous epidemiological studies of smaller non-overlapping populations showed similar results. A rigorous 18-month prospective study of the efficacy of Vioxx's generic form in relieving colon polyps showed an "unanticipated" significant increase in heart attacks among study participants.
Merck's withdrawal of Vioxx was an early victory for Big Data, though it did not win the battle alone. What the controversy did do was demonstrate the power of data mining in live electronic medical records. Graham and his colleagues were able to retrospectively construct what was effectively a clinical trial based on over 2 million patient-years of data. The fact that EMR records are not as rigorously accurate as clinical trial data capture was rendered moot by the huge volume of data analyzed.
Today, the value of Big Data in epidemiology is unquestioned, and the current focus is on developing better analytics and in parallel addressing concerns about patient privacy. The HITECH Act and Obamacare are increasing the rate of electronic biomedical data capture, and improving the utility of such data by requiring the adoption of standardized data structures and controlled vocabularies.
We are witnessing the dawning of an era, and hopefully the start of the transformation of our broken healthcare system into a learning organization.
I believe if we reduce the time between intention and action, it causes a major change in what you can do, period. When you actually get it down to two seconds, it’s a different way of thinking, and that’s powerful. And so I believe, and this is what a lot of people believe in academia right now, that these on-body devices are really the next revolution in computing.
I am convinced that wearable devices, in particular heads-up devices of which Google Glass is an example, will be playing a major role in medical practice in the not-too-distant future. The above quote from Thad Starner describes the leverage point such devices will exploit: the gap that now exists between deciding to make use of a device and being able to carry out the intended action.
Right now it takes me between 15 and 30 seconds to get my iPhone out and do something useful with it. Even in its current primitive form, Google Glass can do at least some of the most common tasks for which I get out my iPhone in under five seconds, such as taking a snapshot or doing a Web search.
Closing the gap between intention and action will open up potential computing modalities that do not currently exist, entirely novel use case scenarios that are difficult even to envision before a critical mass of early adopter experience is achieved.
The Technology Review interview from which I extracted the quote raises some of the potential issues wearable tech needs to address, but the value proposition driving adoption will soon be truly compelling.
I'm adding some drill-down links below.
Practices tended to use few formal mechanisms, such as formal care teams and designated care or case managers, but there was considerable evidence of use of informal team-based care and care coordination nonetheless. It appears that many of these practices achieved the spirit, if not the letter, of the law in terms of key dimensions of PCMH.
One bit of good news about the Patient Centered Medical Home (PCMH) model: here is a study showing that in spite of considerable challenges to PCMH implementation, the transformations it embodies can be and are being implemented even in small primary care practices serving disadvantaged populations.
"All patient and care records digital,
real time and interoperable by 2020."
|"Clinicians in primary, urgent |
and emergency care, and other key transitions
of care contexts will be operating without paper records by 2018."
|"Patients have access to their hospital,|
community, mental health and social care services records by 2018."
"By April 2016, commissioners and providers
must publish "road maps" showing how they
will develop interoperable digital records
and services by 2020."
Should more types of health data figure into electronic health records?
On the one hand, the Institute of Medicine put out a call for doing just that on the grounds that behavioral and social data can benefit population health practices to ultimately improve the care of individual patients. For physicians who already complain that EHRs are burdensome and distract from care delivery, on the other hand, the idea of making electronic records more complex, perhaps even cluttered, will inevitably be unwelcome news. ...
|educational attainment, stress, depression|
physical activity, stress
social isolation, intimate partner violence (for women of reproductive age)
|financial resource strain,|
neighborhood median household income
Twitter, like the Internet in general, has become a vast source of and resource for health care information. As with other tools on the Internet it also has the potential for misinformation to be distributed. In some cases this is done by accident by those with the best intentions. In other cases it is done on purpose such as when companies promote their products or services while using false accounts they created.
In order to help determine the credibility of tweets containing health-related content I suggest the using the following checklist (adapted from Rains & Karmikel, 2009):
Ultimately it is up to the individual to determine how to use health information they find on Twitter or other Internet sources. For patients anecdotal or experiential information shared by others with the same illness may be considered very credible. Others conducting research may find this a less valuable information source. Conversely a researcher may only be looking for tweets that contain reference to peer-reviewed journal articles whereas patients and their caregivers may have little or no interest in this type of resource.
Rains, S. A., & Karmike, C. D. (2009). Health information-seeking and perceptions of website credibility: Examining Web-use orientation, message characteristics, and structural features of websites. Computers in Human Behavior, 25(2), 544-553.
The altmetric movement is intended to develop new measures of production and contribution in academia. The following article provides a primer for research scholars on what metrics they should consider collecting when participating in various forms of social media.
If you participate on Twitter you should be keeping track of the number of tweets you send, how many times your tweets are replied to, re-tweeted by other users and how many @mentions (tweets that include your Twitter handle) you obtain. ThinkUp is an open source application that allows you to track these metrics as well as other social media tools such as Facebook and Google +. Please read my extensive review about this tool. This service is free.
You should register with a domain shortening service such as bit.ly, which will provide you with an API key that you can enter into applications you use to share links. This will provide a means to keep track of your click-through statistics in one location. Bit.ly records how many times a link you created was clicked on, the referrer and location of the user. Consider registering your own domain name and using it to shorten your tweets as a means of branding. In addition, you can use your custom link on electronic copies of your CV or at your own web site. This will inform you when your links have been clicked on. You should also consider using bit.ly to create links used at your web site, providing you with feedback on which are used the most often. For example, all of the links in this article were created using my custom bit.ly domain. In addition, you can tweet a link to any research study you publish to publicize as well as keep track of how many clicks are obtained. Bit.ly is a free service.
Another tool to measure your tweets is TweetReach. This service allows you to track the reach of your tweets by Twitter handle or tweet. It provides output in formats that can be saved for use elsewhere (Excel, PDF or the option to print or save your output by link). To use these latter features you must sign up for an account but the service is free.
Buffer is a tool that allows you to schedule your tweets in advance. You can also connect Buffer to your bit.ly account so links used can be included in your overall analytics. Although Buffer provides its own measures on click-through counts this can contradict what appears in bit.ly. This service is free but also has paid upgrade options available that provide more detailed analytics.
Google Scholar Citation Profile
You can set up a profile with Google Scholar based on your publication record. The metrics provided by this service include a citation count, h-index and i10-index. When someone searches your name using Google Scholar your profile will appear at the top before any of the citations. This provides a quick way to separate your articles from someone else who has the same name as you.
Google Feedburner for RSS feeds
If you maintain your own web site and use RSS feeds to announce new postings you can also collect statistics on how many times your article is clicked on. Feedburner, recently acquired by Google provides one way to measure this. You enter your RSS feed ULR and a report is generate, which can be saved in CVS format.
Journal article download statistics
Many journals provide statistics on the number of downloads of articles. Keep track of those associated with your publication by visiting the site. For example, BioMed Central (BMC) maintains an access count of the last 30 days, one year and all time for each of your publications.
Other means of contributing to the knowledge base in your field include participating on web-based forums or web sites such as Quora. Quora provides threaded discussions on topics and allows participants to both generate and respond to the question. Other users vote on your responses and points are accrued. If you want another user to answer your question you must “spend” some of your points. Providing a link to your public profile on Quora on your CV will demonstrate another form of contribution to your field.
Paper.li is a free service that curates content and renders it in a web-based format. The focus of my Paper.li is the use of technology in Canadian Healthcare. I have also created a page that appears at my web site. Metrics on the number of times your paper has been shared via Facebook, Twitter, Google + and Linked are available. This service is free.
Twylah is similar to paper.li in that it takes content and displays it in a newspaper format except it uses your Twitter feed. There is an option to create a personalized page. I use tweets.lauraogrady.ca. I also have a Twylah widget at my web site that shows my trending tweets in a condensed magazine layout. It appears in the side bar. This free service does not yet provide metrics but can help increase your tweet reach. If you create a custom link for your Twylah page you can keep track of how many people visit it.
Analytics for your web site
Log file analysis
If you maintain your own web site you can use a variety of tools to capture and analyze its use. One of the most popular applications is Google Analytics. If you are using a content management system such as WordPress there are many plug-ins that will add the code to the pages at your site and produce reports. WordPress also provides a built-in analytic available through its dashboard.
If you have access to the raw log files you could use a shareware log file program or the open source tool Piwik. These tools will provide summaries about what pages of your site are visited most frequently, what countries the visitors come from, how long visitors remain at your site and what search terms are used to reach your site.
All of this information should be included in the annual report you prepare for your department and your tenure application. This will increase awareness of altmetrics and improve our ability to have these efforts “count” as contributions in your field.